The Ketogenic Diet: What You Need to Know Before Going Keto

Starchy vegetables like potatoes, corn, peas, they’re out along with legumes like beans and lentils. Also watch out for low-fat or diet products too since manufacturers often add sugar.

Welcome to Health Breakthroughs with Dr. Stengler. I’m Dr Mark Stegler and each episode we cut through the noise to bring you practical, science-backed insights for more energy, better health and a life that feels like yours again.

Hey everyone, welcome back to the channel. Today we’re tackling the Ketogenic Diet. What it is, what to eat and to avoid, What’s been studied for, potential side effects, and nutrients you probably need to supplement if you’re on this diet.

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The ketogenic diet, what is it really? Well, it’s a high fat, very low carbohydrate eating pattern that changes how your body produces and uses energy.

Normally, your runs on different fuel sources, including glucose from carbs. But when your carbs dropped around to about 20 to 50 grams a day and you bump up your fat to 78% of your calories, you liver starts breaking down fatty acids into ketone bodies, a state called nutritional ketosis.

On this diet, protein stays moderate, around 15-20%, since excess protein can convert into glucose and kick you out of ketosis. This isn’t a new fad, it was first used in the 1920s for the treatment of epilepsy, but now it’s one of the most well-studied diets in medicine.

Let’s review what foods you can eat. On the ketogenic diet, you’re eating foods that are naturally rich in fat and very low in carbs. That includes meats and poultry, fatty fish and seafood like salmon, sardines, tuna, eggs and full fat dairy.

Dairy products such as cheese, butter, heavy cream and plain Greek yogurt used in moderation. For vegetables, stick with non-starchy options like leafy greens, broccoli, cauliflower, zucchini, also asparagus, peppers and cucumbers.

Nuts and seeds like almonds, walnuts and chia seeds are great too along with healthy fats like olive oil, coconut oil avocado oil and of course avocados.

For drinks stick with water, plain coffee, unsweetened tea and sparkling water. The big theme is whole, minimally processed foods that keep you full without pushing your carbs too high.

Now let’s talk about the foods to avoid. On the flip side, foods you need to limit or cut out since even small amounts of carbs can knock you out of ketosis.

This includes grains and starches. For example, you know the breads, pastas, rice, oats, cereal. Sugary foods and sweets obviously have to go too. And here’s one that surprises people.

Most fruits on this diet are off the table since bananas, apples, oranges, and grapes are too high in natural sugar. Some people allow a small portion of berries here and there, but that’s about it.

Starchy vegetables like potatoes, corn, peas, they’re out, along with legumes like beans and lentils. Also, watch out for low-fat or diet products, too, since manufacturers often add sugar to make up for the missing fat.

Sugary drinks and alcohol, especially beer and sweet mixed drinks, are also off the table. My advice? Read labels carefully. Carbs hide in a lot of packaged foods that don’t even taste sweet.

So what conditions has the ketogenic diet been studied for? Let’s get into the research. The ketogenetic diet has been stayed for several medical conditions with evidence ranging from really solid to still emerging.

First, epilepsy. the strongest evidence we have is for epilepsy and landmark trial in the Lancet Neurology Journal found that after three months, 38% of children on the Ketogenic Diet had more than a 50% reduction in seizures compared to just 6% in the control group.

Updated clinical guidelines still recommend it as a well-validated option for drug-resistant epilepsy. Next is type 2 diabetes and for blood sugar control.

A randomized crossover study in the American Journal of Clinical Nutrition followed 40 adults with pre-diabetes or type 2 diabetes through both a ketogenic diet and a Mediterranean-style diet, 12 weeks of each.

Both improved blood sugar, but the keto diet showed more consistent gains in fasting insulin and triglycerides, or fats in a blood. And a 2024 meta-analysis of 29 trials found significant reductions in fast glucose, A1C, insulin resistance, and triglycerides, again with the ketogenic approach.

Now let’s talk about obesity and weight management, which also ties into blood sugar control. A randomized controlled trial in the journal Nutrients compared a healthy ketogenetic diet to a standard calorie-restricted diet in 80 adults with obesity over six months.

And the Ketogenic group had greater reductions in weight, body mass index, and visceral fat. The 2022 meta-analysis backed this up. showing better improvements in weight, blood sugar, and cholesterol for overweight people with type 2 diabetes.

Now, one that doesn’t get talked about enough is non-alcoholic fatty liver disease, abbreviated NAFLD, now sometimes called or abbreviate it MASLD. And it affects around 30 to 38% of the global population.

A study in the Proceedings of the National Academy of Sciences found that only six days of a ketogenic diet reduced liver fat by 31% and cut down liver insulin resistance by 58%, despite only a 3% drop in body weight.

Other studies have shown that a low-carb ketogenic diet is also good for fatty liver, improving liver fat, inflammation, and even a trend towards less scar tissue of the liver.

A 2024 review summed up well that the ketogenetic diet seems to hit multiple drivers of fatty livers all at once. Hey everybody, I want to take just a quick moment and invite you to my website drstengler.com.

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Then there’s also research into neurological conditions like Alzheimer’s, Parkinson’s and traumatic brain injury, based on the idea that the brain can use ketones for fuel when it struggles with glucose.

One randomized double-blind trial found that a ketogenic medical food improved cognitive function in some Alzheimer patients, especially those without a genetic variant called APOE4.

And finally, cancer. Many cancer cells rely heavily on glucose, known as the Warburg effect. So the theory is that ketosis might put them at a metabolic disadvantage, that is the cancer cell.

A 2025 meta-analysis pooled multiple trials of cancer patients and found that a ketogenic diet significantly reduced fat mass, visceral fat, insulin, blood glucose fatigue and insomnia while improving cholesterol markers, thyroid markers and emotional well-being.

The effect on actual tumor progression was inconsistent, so this is still something you would need to have your oncology team monitor. Now let’s talk about the potential downsides of the ketogenic diet, because no diet is perfect.

The most common side effect is known as the keto flu. In the first one to two weeks, as your body switches from burning glucose to burning fat, you might get headaches, fatigue, brain fog, irritability, nausea, and muscle cramps.

This comes mostly from rapid fluid and electrolyte loss as insulin levels drop. So it’s important to drink enough fluids and get enough electrolytes because these get depleted so quickly.

Other things to watch out for on this diet. Constipation, since you’re cutting out a lot of fiber sources. Some people also see their LDL cholesterol levels rise.

This can be monitored. Kidney stones can also be a concern, especially in kids using this for epilepsy. And in rare cases, with certain underlying conditions, there is a risk of diabetic ketoacidosis.

which is different from the nutritional ketosis we’re talking about for the average person. And because you’re cutting out whole food groups, micronutrient deficiencies are also a real risk if you are not careful.

This diet may not be appropriate if have pancreatitis, advanced liver disease, or you have certain genetic fat metabolism disorders, so check with your integrative doctor on this.

And here’s one thing that doesn’t get addressed enough, and that’s your gallbladder. Because this diet is so high in fat, your Gallbladder has to release more bile to digest it.

And combined with rapid early weight loss, this can increase your risk of gallstones or trigger symptoms if you’re already having gall stones. So you have to be aware of upper right abdominal pain, nausea, digestive discomfort.

So, if you have a history of gallstones, then this is something you need to talk to your integrative doctor about before starting. What about the nutrients that you may need supplement?

Because this so important, we don’t want to end up with nutritional deficiencies which causes a bunch of symptoms. I talked about electrolytes, sodium, potassium and especially magnesium.

They get flushed out fast in early ketosis and low magnesium can cause cramps, poor sleep and fatigue. Many doctors like myself recommend 300-500 mg of magnesium glycinate daily, plus enough sodium potassium rich foods like avocado and leafy greens to bump up these minerals.

Second, vitamin D. Most people are low in vitamin d already, so it’s worth checking your levels. most of my patients need between 2000 to 5000 units daily.

Also omega-3 fatty acids like EPA and DHA. If you’re not eating enough fatty fish regularly, especially on this diet, then you may want to supplement omega 3s to keep your omega 6 to omega three ratio balanced.

also B vitamins, specially vitamin B1, thiamine. It’s important for energy metabolism and it can get low on a low carb restricted diet. A bee complex is really the best way to replace your bees.

Then fiber, something like psyllium husks can help since you’re cutting out a lot of foods that normally help keep things moving and you need more fiber.

Also consider calcium, especially if you are limiting dairy in your keto diet, even though you can have it. Around 500 to 1000 milligrams a day might be needed depending on how your diet is.

So that’s the ketogenic diet in a nutshell. What it is, what to eat, and what avoid. what’s been studied for, the side effects to watch for and the nutrients you might want to supplement.

It’s a powerful dietary tool, but not a one size fits all. So I always recommend working with a health care provider trained in nutrition, especially if you have chronic health conditions and you’re going to make big changes in your diet.

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